Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

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A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

Journal of Tissue Engineering ◽

10.1177/2041731416686532 ◽

2016 ◽

Vol 8 ◽

pp. 204173141668653 ◽

Cited By ~ 6

Author(s):

Jeffrey CY Chan ◽

Krishna Burugapalli ◽

Yi-Shiang Huang ◽

John L Kelly ◽

Abhay Pandit

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Rabbit Model ◽

In Vivo Model ◽

Abdominal Wall Defects ◽

Tissue Samples ◽

Collagen Formation ◽

Hernia Formation ◽

Surgical Meshes

An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

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Early versus Delayed Complex Abdominal Wall Reconstruction with Biologic Mesh Following Damage Control Surgery

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003011 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Shekhar Gogna ◽

Rifat Latifi ◽

James Choi ◽

Jorge Con ◽

Kartik Prabhakaran ◽

...

Keyword(s):

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Damage Control Surgery ◽

Biologic Mesh

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Discussion on the Key Factors for the Treatment of Extremely High-risk Abdominal Trauma Patients With Partial Full-thickness Abdominal Wall Defects

10.21203/rs.3.rs-1078551/v1 ◽

2021 ◽

Author(s):

JiaQing Gong ◽

MingHui Pang ◽

Wei Li ◽

GuoDe Luo ◽

ZhiBing Yuan ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Abdominal Trauma ◽

Successful Treatment ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Wall Defects ◽

Trauma Patients ◽

Full Thickness ◽

Key Factors

Abstract BackgroundPatients with extremely high-risk abdominal trauma and full-thickness necrosis and defects of the partial abdominal wall are clinically rare, and the treatments for these patients are very difficult and complex . In this study, we will explore the key factors for successful treatment of these patients . MethodsThree patients with extremely high-risk abdominal trauma and partial full-thickness abdominal wall defects were involved in this retrospective study, and one representative case was emphatically reviewed. According to the theory of damage control surgery,the consultation and coordinated treatment of multidisciplinary team(MDT) were involved firstly, then, stepped multiple operations,such as partial perforated small bowel resection, full-thickness abdominal wall defects repair, vacuum sealing drainage (VSD), and wounds skin grafts, were performed, meanwhile, systemic life resuscitation was strengthened. ResultsTwo patients were cured and discharged after 3 and 9 operations respectively. One patient suffered 2 operations and eventually died of lung infection and respiratory failure. ConclusionThe determination and responsibility of surgeons, rational use of damage control theory and multidisciplinary cooperation should be the keys for successful treatment.

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Beyond Damage Control Surgery: Abdominal Wall Reconstruction and Complex Hernia Repair

Penetrating Trauma ◽

10.1007/978-3-662-49859-0_44 ◽

2016 ◽

pp. 341-349

Author(s):

Rifat Latifi

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Damage Control Surgery

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Biomechanical Behaviour and Biocompatibility of Ureidopyrimidinone-Polycarbonate Electrospun and Polypropylene Meshes in a Hernia Repair in Rabbits

Materials ◽

10.3390/ma12071174 ◽

2019 ◽

Vol 12 (7) ◽

pp. 1174 ◽

Cited By ~ 2

Author(s):

Mori da Cunha ◽

Hympanova ◽

Rynkevic ◽

Mes ◽

Bosman ◽

...

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Muscular Atrophy ◽

Abdominal Wall Defect ◽

Fatty Infiltration ◽

Pelvic Organ ◽

Abdominal Wall Defects ◽

Full Thickness ◽

Recurrence Rates

Although mesh use has significantly improved the outcomes of hernia and pelvic organ prolapse repair, long-term recurrence rates remain unacceptably high. We aim to determine the in vivo degradation and functional outcome of reconstructed abdominal wall defects, using slowly degradable electrospun ureidopyrimidinone moieties incorporated into a polycarbonate backbone (UPy-PC) implant compared to an ultra-lightweight polypropylene (PP) textile mesh with high pore stability. Twenty four New-Zealand rabbits were implanted with UPy-PC or PP to either reinforce a primary fascial defect repair or to cover (referred to as gap bridging) a full-thickness abdominal wall defect. Explants were harvested at 30, 90 and 180 days. The primary outcome measure was uniaxial tensiometry. Secondary outcomes were the recurrence of herniation, morphometry for musculofascial tissue characteristics, inflammatory response and neovascularization. PP explants compromised physiological abdominal wall compliance from 90 days onwards and UPy-PC from 180 days. UPy-PC meshes induced a more vigorous inflammatory response than PP at all time points. We observed progressively more signs of muscle atrophy and intramuscular fatty infiltration in the entire explant area for both mesh types. UPy-PC implants are replaced by a connective tissue stiff enough to prevent abdominal wall herniation in two-thirds of the gap-bridged full-thickness abdominal wall defects. However, in one-third there was sub-clinical herniation. The novel electrospun material did slightly better than the textile PP yet outcomes were still suboptimal. Further research should investigate what drives muscular atrophy, and whether novel polymers would eventually generate a physiological neotissue and can prevent failure and/or avoid collateral damage.

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Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500002 ◽

2005 ◽

Vol 20 (5) ◽

pp. 347-352 ◽

Cited By ~ 30

Author(s):

Alberto Goldenberg ◽

Jacques Matone ◽

Wagner Marcondes ◽

Fernando Augusto Mardiros Herbella ◽

José Francisco de Mattos Farah

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Peritoneal Cavity ◽

Abdominal Cavity ◽

Mesh Fixation ◽

Rabbit Model ◽

Laparoscopic Approach ◽

Preperitoneal Space ◽

Similar Amount ◽

The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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Abdominal Wall Reconstruction

10.2310/ps.10056 ◽

2018 ◽

Author(s):

Gregory A. Dumanian

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Abdominal Wall Defects ◽

Gap Formation ◽

Rectus Diastasis ◽

Dramatic Form ◽

Tensile Forces ◽

Surgical Failure ◽

Pull Through ◽

Abdominal Shape

The closure of the abdominal wall defects is a fascinating field within surgery. The combined strength of sutures and scar after simple approximation of tissues in many cases does not suffice to contain the abdominal viscera and an incisional hernia results. Surgical failure can be seen immediately in the dramatic form of a dehiscence or can emerge slowly over time with a change in the abdominal shape and contour. This chapter delves into the theory and practicum of how a surgeon can approximate two halves of an abdominal wall together to resist the inherent tensile forces that exist and create a durable closure. This review contains 19 figures and 35 references Key Words: bioprosthetic, bridging, component release, force distribution, foreign body reaction, gap formation, hernia, laparotomy, mesh, perforator preservation, rectus diastasis, suture pull-through, TAR release

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An Innovative Way to Separate Gastrointestinal and Abdominal Wall Reconstruction after Complex Abdominal Trauma

The American Surgeon ◽

10.1177/000313481708300938 ◽

2017 ◽

Vol 83 (9) ◽

pp. 1001-1006 ◽

Cited By ~ 1

Author(s):

David H. Livingston ◽

David V. Feliciano

Keyword(s):

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Skin Grafting ◽

Small Bowel Resection ◽

Fascial Closure ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Staged Approach ◽

Level I

Despite advances in trauma care, a subset of patients surviving damage control cannot achieve fascial closure and require split-thickness skin grafting (STSG) of their open abdomen. Controversy exists as to whether reconstruction of the gastrointestine (GI) should be staged or performed at the time of abdominal wall reconstruction (AWR). Many surgeons do not believe that operations through the STSG can be completed safely or without loss of graft. This series reviews the outcomes of operations for GI reconstruction performed through the elevated healed STSG. Concurrent series on all patients undergoing abdominal operation through the STSG. The technique involves elevating the STSG, lysing adhesions only as needed, avoid detaching underlying omentum or viscera to avoid devascularization, and then reattaching the elevated STSG to the abdominal wall with simple sutures. From 1995 to 2017, 27 patients underwent 40 distinct procedures during 36 separate abdominal reoperations (89% GI) through the elevated STSG approach at three Level I trauma centers at a mean interval of 11 months from application of the STSG. One STSG was lost (patient closed with skin flaps), one patient had 30 per cent loss of the STSG (regrafted), and one patient had 10 per cent loss of the STSG (allowed to granulate). One patient required a small bowel resection for intraoperative enterotomy during a difficult operative dissection. There were no GI complications, intraabdominal infections, or deaths, and all patients were deemed fit to undergo AWR after three months. Major intraabdominal reoperations can be readily and safely accomplished through the elevated STSG approach with a <4 per cent need for regrafting. This staged approach significantly simplifies and increases the safety of a second stage AWR.

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